Provider Demographics
NPI:1982712410
Name:TAKENAKA, CHERRIE MAUREEN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERRIE
Middle Name:MAUREEN
Last Name:TAKENAKA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:CHERRIE
Other - Middle Name:MAUREEN
Other - Last Name:MIKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:618 W GRAVES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2317
Mailing Address - Country:US
Mailing Address - Phone:509-466-1665
Mailing Address - Fax:
Practice Address - Street 1:618 W GRAVES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2317
Practice Address - Country:US
Practice Address - Phone:509-466-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00056735163W00000X
WAAP390003432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9624453Medicaid
WAS77962Medicare UPIN